PBM RFP Management Service
Finding the optimal Pharmacy Benefit Manager (PBM) for your employer-sponsored health plan is challenging and essential – and that’s why the request for proposal (RFP) process is so crucial.
At TFG Partners, we understand how much you have on the line, so we offer our PBM RFP Management Service as the solution. With decades of experience in pharmacy benefit auditing and vendor oversight, we bring deep industry knowledge and an unbiased approach to every PBM selection process.
The key is entering a PBM contract that operates transparently and effectively, as confirmed by active oversight. Our service helps you meet your members’ needs while managing costs, meeting increasingly stringent regulatory requirements, and avoiding costly and reputation-harming legal headaches.
The PBM RFP Process Explained
TFG Partners understands that your pharmacy benefit program has to meet your organizations unique needs. Therefore, service levels, and capabilities to offer better quality programs are as much a part of the value equation as cost for members and the plan.
Our RFP process uses a well-structured roadmap that starts with your needs before taking both quantitative as well as qualitative aspects of your prospective PBM partners value into consideration. Using your specific benefit objectives, plan designs, as well as actual utilization of your unique employee population are critical in this complex evaluation
The roadmap includes a detailed outline of the plan’s requirements, expectations, and evaluation criteria for selecting an Rx partner.
Our RFP Review Service compares competitive bids from several PBM options. We thoroughly assess the service fit with benefit needs as well as cost-effectiveness and likely savings of each option in a fact-based, objective manner. It includes a customized review based on net claims costs after discounts, rebates, fees, incentives, etc., for each vendor, using the actual mix of your plan’s last 12 months of claim experience as the basis for comparison. And a comparison that reprices every single claim.
Unlike the evaluation of a medical plan claim administration agreement, a PBM evaluation must also focus on complex financial issues, as detailed in the next section.
How We Review and Compare PBMs
Benefit Analysis
- Plan design: all specific requirements of the active or future plan are reviewed and taken into consideration and become part of the workbook specifying what standards need to be met
- Programs: All programs that improve your members outcomes and/or improve the value such as prior authorization, step therapy and even specific clinical programs such as diabetes or weight management are being included as part of the RFP requirements
- Clinical Management: Optionally, clients can request a review of clinical management program as many point solutions are now available from the PBM or third-party vendors to further improve outcomes and reduce costs.
Financial Analysis
- Discount Guarantees: Evaluate the point-of-sale ingredient costs and ensure they are competitive
- Dispensing Fees: Analyze Rx dispensing fees and compare them to market rates
- Rebate Guarantees: Assess the rebate structures and ensure they provide adequate savings
- PBM Administrative Fees: Review proposed management fees to ensure they are justified
Contract Review
- Contract Definitions: Ensure clear and unambiguous definitions to prevent PBMs from shifting drugs between guarantees
- Pricing Transparency: Advocate for pass-through pricing to prevent your PBM from taking a profit spread on every drug dispensed
- Financial Benefit Guarantees: Seek guarantees that go beyond rebate guarantees to include other valuable financial benefits
- Audit and Market Check Rights: Ensure you retain audit and market check rights to verify compliance and competitiveness
- Flexibility in Contract Terms: Ensure the contract allows for adjustments as the market changes
Operational Performance
- Claims Processing: Evaluate the pharmacy claims processing capabilities and member services
- Member Disruption: Assess the PBM’s proactive approach to resolving rejected claims and minimizing member disruption
- Communication and Flexibility: Ensure the assigned account managers have strong communication skills and can respond effectively to your needs
Additional Considerations
- Formulary Design: Review formulary design and its impact on your members’ access to medications
- Specialty Drug Management: Evaluate the PBM’s capabilities in managing specialty drugs and ensuring access for members
- 340B Pharmacy Partnerships: If applicable, ensure the PBM RFP process considers partnerships with 340B pharmacies
We Help Rx Plan Sponsors with RFPs at Every Step
Let our TFG Partners team guide you through every step of the RFP process—from strategy to selection—ensuring your plan and your members get the value they deserve.
Strategic Planning & Needs Assessment
We work with your team to understand your current PBM relationship, performance concerns, and long-term goals—ensuring the RFP is tailored to your needs.
Custom RFP Development
We draft clear, comprehensive RFP documents that reflect your priorities, whether they’re pricing transparency, rebate guarantees, specialty drug management, or clinical program support.
Market Intelligence & Vendor Outreach
Leverage our knowledge of the PBM landscape to identify qualified vendors, emerging options, and potential disruptors in the market.
Proposal Evaluation & Cost Analysis:
We use a proprietary scoring model and detailed financial analysis to compare proposals on pricing, contract terms, service performance, and alignment with your goals.
Finalist Support & Contract Review
From finalist interviews to contract negotiation, we provide objective insights and technical support to ensure the selected PBM delivers value and accountability.
What Makes TFG Partners Stand Apart?
We understand that you have a choice among pharmacy claim auditors and benefit plan consulting firms, and we strive to add extra value for the trust you place in us.
Our people have pioneered many of the “best practices” widely used in our field today, and we bring the same experience and commitment to excellence to your RFP review.
- Unbiased guidance with no ties to PBM vendors
- Deep expertise in pharmacy benefit auditing and compliance
- Rigorous approach to pricing and contract analysis
- Focused on long-term performance, not just short-term savings
- Seamless capabilities to monitor and audit program performance once you make a selection
Whether it’s going with a new company or improving the contract with your current provider, we’ll help you make your next PBM decision with greater confidence — our only allegiance is to your plan. We put you and your needs first at every step.
PBM RFP Management FAQs
What is PBM RFP management, and why do we need it?
A PBM RFP is the formal process of soliciting and comparing bids from pharmacy benefit managers, and managing it well is what actually determines whether the contract you sign performs the way it looks on paper. PBM pricing is complicated enough — discount guarantees, rebate structures, dispensing fees, administrative fees — that most of the real risk and opportunity lives in details a simple side-by-side comparison won’t surface. TFG Partners has the skills and systems to help employers and their consultants quantify all these elements to get a clear apples to apples comparison of your options.
How is TFG Partners’ PBM RFP process different from running it ourselves or through a broker?
We reprice every claim from your last 12 months of actual plan experience against each competing bid, so you’re comparing real numbers instead of a generic quote built on assumptions. We also have no financial relationship with any PBM — not always true of every coalition or broker option running an RFP, since some are compensated in ways tied to which vendor gets selected. By working directly with TFG or having your broker or consultant work with us, you are guaranteed to get an objective bottom line picture, regardless if there is a unique way used to compensate your other trusted partners.
What are pass-through pricing and audit rights, and why do they matter in a PBM contract?
Pass-through pricing means the PBM passes along its actual drug acquisition cost plus a disclosed fee, instead of quietly keeping a spread on every prescription filled. Audit and data-access rights are what let you verify that’s actually happening — without contract language guaranteeing access to claims-level data, you’re taking the PBM’s pricing on faith. Both are terms we push for in every RFP we manage.
What does it mean to work with a data-centric, fiduciary-first PBM with built-in audit tools?
Some PBM contracts are structured so the plan sponsor — not just the PBM — has direct access to claims-level data and the tools to audit it independently. That’s the general direction the market is moving, partly driven by newer federal and state transparency laws, and it’s worth pushing for transparency specifically in contract negotiations. A PBM that resists giving you real data access is usually the one with the most reason to do so.
Should we run a PBM RFP even if we’re satisfied with our current PBM?
Worth doing anyway. PBM pricing and the competitive landscape shift enough year to year that a market check can either confirm you’re getting a fair deal or hand you real leverage to renegotiate. Most sponsors run the process for exactly that reason, not necessarily to switch vendors.
What is a Market Check?
Most contracts allow for a mid-term “Market Check” that enables you to compare your contract against the latest most competitive pricing in what is a rapidly changing market using a process akin to a full RFP, also available through TFG. Market Checks are often compensated for by your incumbent PBM while your contract might have a clause that gives the incumbent PBM the change to match the market if alternative vendors offer significantly lower prices or allow you to switch.
How much of our own team’s time does an RFP process actually take?
Less than most people expect, and it’s front-loaded rather than spread evenly. Your team’s heaviest involvement is early on — defining priorities and plan requirements — and again at the end, reviewing finalists and weighing in on the final decision. In between, TFG Partners handles vendor outreach, proposal scoring, and the financial analysis directly, so the RFP isn’t sitting on anyone’s desk as an ongoing task for months.